This book provides an alternative, complementary approach to the existing conventional approaches to religious and spiritually oriented coping. By focusing on the role of culture, the authors take into account the methods employed by a vast number of people who do not directly identify themselves as religious. The empirical data used in this book derive from studies conducted in several countries; Sweden, China, South Korea, Turkey and Malaysia, across which religion plays a different role in the social and cultural life of individuals. This approach and these empirical data are unique and allow comparisons to be made between different cultural settings.

By introducing the concept of meaning-making coping, the authors explore the influence of culture on choice of coping methods, be they purely religious, spiritual or existential. The term "existential meaning-making coping" is used to describe coping methods that are related to existential questions; these methods include religious, spiritual and existential coping methods.

Meaning-making Methods for Coping with Serious Illness contributes to new approaches and theoretical models of coping. As such it is an invaluable resource for health care, medical, public health and sociology students and researchers. It will also be of interest to educators and policy-makers working in the area of health.

The authors have conducted a quantitative survey to examine the extent to which the results obtained in a qualitative study among cancer patients in Sweden (Ahmadi, Culture, religion and spirituality in coping: The example of cancer patients in Sweden, Uppsala, Acta Universitatis Upsaliensis, 2006) are applicable to a wider population of cancer patients in this country. In addition to questions relating to the former qualitative study, this survey also references the RCOPE questionnaire (designed by Kenneth I Pargament) in the design of the new quantitative study. In this study, questionnaires were distributed among persons diagnosed with cancer; 2,355 people responded. The results show that nature has been the most important coping method among cancer patients in Sweden. The highest mean value (2.9) is the factor ‘nature has been an important resource to you so that you could deal with your illnesses’. Two out of three respondents (68 %) affirm that this method helped them feel significantly better during or after illness. The second highest average (2.8) is the factor ‘listening to ‘natural music’ (birdsong and the wind)’. Two out of three respondents (66 %) answered that this coping method significantly helped them feel better during illness. The third highest average (2.7) is the factor ‘to walk or engage in any activity outdoors gives you a spiritual sense’. This survey concerning the role of nature as the most important coping method for cancer patients confirms the result obtained from the previous qualitative studies.

To understand the role of culture on the use of the meaning-making coping among people who have been struck by cancer, qualitative and quantitative studies have been conducted in several countries like Sweden, China, Japan, South Korea, Malaysia, Philippines, and Turkey. This article reports on a quantitative study carried out in Turkey. The aim of the study has been to answer the following question: “Which meaning-making coping method (even nonreligious or spiritual coping methods) is used by informants?” The sample consists of 95 persons, 18+ who had been struck by cancer. The questionnaire was distributed to former/current cancer patients via a web address as an electronic survey through the media page of Cancer Survivors Association. The results of the study show that the most important coping methods used by cancer patients in Turkey are the religious coping (RCOPE) methods, particularly spiritual connection, active religious surrender, passive religious deferral, and pleading for direct intercession. Several RCOPE methods such as spiritual discontent, seeking support from clergy or members, punishing God reappraisal, and demonic reappraisal or self-directing religious coping are not used by the Turkish informants. Nor are non-RCOPE methods highly prevalent among informants.

The aim of this article is to elucidate and discuss the results of the 2016 Diversity Barometer (Mångfaldsbarometern) and compare these results with those obtained from ten years of the longitudinal Diversity Barometers for 2005?2014. An additional aim is to demonstrate whether and how Swedish people?s experiences of and attitudes toward people with a foreign background and ethnic diversity have changed.A random sample of the Swedish population took part in the annual study, which was carried out in the form of a nationwide postal survey. The results show that negative attitudes toward ethnic and cultural diversity in general, and migrant population in particular, have increased to some extent and with respect to certain issues. Views on diversity in relation to culture and religion ? especially Islam ? were more negative than views on diversity in relation to work. Those who have larger experience of contact with foreigners show a more positive attitude toward diversity compared with those with limited experience and contact. Individuals who have higher education, those who identify themselves as female, younger persons and those living in large cities are more positive than other groups. In our analysis of the empirical data, we proceeded from a social work perspective and applied contact theory and group conflict theories relating attitudes to group position.

The purpose of the present project has been to carry out international studies on meaning-making coping among people who have been affected by cancer in a number of societies and, thereby, to try to understand the influence of culture on use of these coping methods. Five countries—Sweden, South Korea, China, Japan, and Turkey—are included in the project. Qualitative semistructured interviews have been conducted with persons with a cancer diagnosis. The research group in each country has used, as a foundation, the interview questions developed for the Swedish study. These questions were, however, modified to better suite the sociocultural context of each participating country. The results presented here concern only Turkey and are restricted to religious coping methods. The study consists of 25 cancer patients (18 females and 7 males) between 20 and 71 years of age. The results of the study in Turkey indicated that the RCOPE (Religious Coping) methods are highly relevant for the interviewees. A sociological analysis of the study made from a cultural perspective showed clearly the importance of the idea of being tolerant (Sabr) for patients when coping with the psychological problems brought about by cancer. The study made it clear that culture plays an essential role in the choice of coping methods.

The present article is based on an international study on meaning-making coping aimed at understanding the role of culture in coping. The larger study has been conducted among cancer patients in 10 countries. The present article is confined to the results obtained in our study in Iran and restricted to religious coping methods. Twenty-seven participants with various kinds of cancer were interviewed. The several religious coping methods found in the present study are categorised on the basis of RCOPE?s five basic religious functions. The study reveals, among others, the impact of cultural beliefs on certain religious coping methods, even among those who are not regarded as practicing Muslims. The study highlights the importance of investigating cultural and social context when exploring the use of the meaning-making coping strategies in different countries.

The present article is part of an international study on meaning-making coping aimed at understanding the role of culture in coping in different cultural settings. The international study was conducted among cancer patients in ten countries. This article contains the results obtained in the study in Portugal. The main aim is to investigate the impact of culture on the meaning-making coping methods used by cancer patients. In the present article, only religious/spiritual coping methods are in focus.

Thirty-one participants with various kinds of cancer (e.g., breast, testicular, lymphoma) were interviewed. Nine different kinds of coping methods related to religion and spirituality emerged from analysis of the interviews. These methods, which are categorized on the basis of RCOPE’s five basic religious functions (Pargament, 1997), are: Seeking Spiritual Support, Spiritual Connection, Spiritual Discontent, Benevolent Religious Reappraisal, Punishing God Reappraisal, God’s Trust in Personal Strength, Support from Clergy or Members, Self-Directing Religious Coping and Active Religious Surrender. The study confirms the notion that the strategies people employ when they are stricken by disease, accidents, misfortune, etc., are cultural and temporal constructions. As such, they are valid in concrete contexts and time periods. It is, thus, important that cultural context be taken into consideration when exploring the use of meaning-making coping strategies in different countries.

The present study compared meaning-making coping among cancer patients in Sweden and South Korea, with a focus on the sociocultural context. Semi-structured interviews were conducted with 51 Swedes and 33 Koreans. The results showed significant differences between the two countries as well as similarities in existential, spiritual, and religious coping. For example, Swedes primarily used meaning-making coping as a means of meditation or relaxation, whereas Koreans relied on coping with prayer and using healthy foods as a means to survive. The present study confirms the significance of investigating cultural context when we explore the use of meaning-making coping among people who have experienced cancer.

The present study aimed to explore the use of meaning-making coping (existential, spiritual, and religious coping) among cancer patients in Korea and to investigate the impact of culture on their choice of coping methods. Thirty-three participants with various kinds of cancer were interviewed. Four different kinds of coping resources emerged from analyses of the interview transcripts: (1) belief in the healing power of nature; (2) mind–body connection; (3) relying on transcendent power; and (4) finding oneself in relationships with others. The findings of this study suggest the importance of investigating cultural context when exploring the use of the meaning-making coping strategies in different countries.

The present article is written on the basis of a sociological international project on meaning-making coping. The aim of the project has been to understand the role of culture in meaning-making coping. The project embarrasses studies among cancer patients in 10 countries. The present article is confined to the results obtained in the study in japan. The main aim was to investigate the impact of culture from a sociological perspective on the choice of coping methods. Twelve participants with various kinds of cancer were interviewed. Several meaning-making coping methods are found in the present study. This study underlines the importance of investigating cultural and social context when investigating into the use of the meaning-making coping methods in different countries.

For understanding the role of culture in coping in different cultural settings, we have conducted studies among cancer patients in 10 countries, within the framework of an international study on meaning-making coping. This article reports on part of the results we obtained from a study in Portugal; specifically, the reported findings are restricted to nonreligious/spiritual coping methods, methods we call secular existential meaning-making coping. The main aim is to identify the diversity of coping methods using a cultural lens. Thirty-one participants with various kinds of cancer were interviewed. Six different kinds of coping methods related to secular existential coping emerged from thematic analyses of the interviews: discourse of the self, positive solitude, nature, positive transformational orientation, body–mind relationship, and working. Findings revealed that these six methods facilitated patients’ psychological adaptation to the oncological disease. The findings suggest the importance of considering cultural and social context when exploring coping strategies among cancer patients.

In the present article, based on results from a survey study in Sweden among 2,355 cancer patients, the role of religion in coping is discussed. The survey study, in turn, was based on earlier findings from a qualitative study of cancer patients in Sweden. The purpose of the present survey study was to determine to what extent results obtained in the qualitative study can be applied to a wider population of cancer patients in Sweden. The present study shows that use of religious coping methods is infrequent among cancer patients in Sweden. Besides the two methods that are ranked in 12th and 13th place, that is, in the middle (Listening to religious music and Praying to God to make things better), the other religious coping methods receive the lowest rankings, showing how nonsignificant such methods are in coping with cancer in Sweden. However, the question of who turns to God and who is self-reliant in a critical situation is too complicated to be resolved solely in terms of the strength of individuals’ religious commitments. In addition to background and situational factors, the culture in which the individual was socialized is an important factor. Regarding the influence of background variables, the present results show that gender, age, and area of upbringing played an important role in almost all of the religious coping methods our respondents used. In general, people in the oldest age-group, women, and people raised in places with 20,000 or fewer residents had a higher average use of religious coping methods than did younger people, men, and those raised in larger towns.

The purpose of the present project has been to carry out international studies on meaning-making coping among people who have been affected by cancer in a number of societies and, thereby, to try to understand the influence of culture on use of these coping methods. Five countries—Sweden, South Korea, China, Japan, and Turkey—are included in the project. Qualitative semistructured interviews have been conducted with persons with a cancer diagnosis. The research group in each country has used, as a foundation, the interview questions developed for the Swedish study. These questions were, however, modified to better suite the sociocultural context of each participating country. The results presented here concern only Turkey and are restricted to religious coping methods. The study consists of 25 cancer patients (18 females and 7 males) between 20 and 71 years of age. The results of the study in Turkey indicated that the RCOPE (Religious Coping) methods are highly relevant for the interviewees. A sociological analysis of the study made from a cultural perspective showed clearly the importance of the idea of being tolerant (Sabr) for patients when coping with the psychological problems brought about by cancer. The study made it clear that culture plays an essential role in the choice of coping methods.

Doping – the use of performance-enhancing substances and methods – has long been a high-profile issue in sport but in recent years it has also become an issue in wider society. This important new book examines doping as a public health issue, drawing on a multi-disciplinary set of perspectives to explore the prevalence, significance and consequences of doping in wider society. It introduces the epidemiology of doping, examines the historical context, and explores the social, behavioural, legal, ethical and political aspects of doping. The book also discusses possible interventions for addressing the problem on organisational and societal levels.

The concept of “doping” is usually associated with sport, particularly elite sport. In fact, doping means the use of substances or methods that are banned in sport by the World Anti-Doping Agency (WADA) because of their potentially performance-enhancing effects. Their use is, therefore, considered to be against the fair play spirit of sport and can also include significant health risks for the user. However, the use of many doping substances is no longer limited to the world of sport. Doping substances such as anabolic androgenic steroids (AAS) are nowadays used also by people who are not competitive athletes but who want to make use of the effects of AAS in making their bodies more muscular, stronger and impressive in conformity with the current masculine body ideal. The use of AAS and similar substances appears to be growing and has been found in a range of countries previously not researched. At least, recent data obtained from customs seizures, court cases and some surveys suggest that the extent of AAS use outside sport has been underestimated, some reasons probably being an underground circulation of such drugs in the gym and fitness culture and the easy availability of them on the internet. One particular concern is the increasing use of nutritional supplements by growing segments of society. A significant percentage of these products have been shown to contain prohibited substances such as steroids that are not listed on the label. This shows that the nutritional supplement industry needs to be more strictly regulated. Until that happens, supplements of dubious value, content and quality will continue to be easily available around the world. What, then, are the possible reasons that active and health-conscious individuals are willing to take the risk to use preparations such as AAS? A review of the research shows that the most important motive behind the use of AAS outside the elite sports environment, i.e., in a fitness context, is to improve physical appearance. Although most users are boys and young and middle-aged men, also women of various ages use doping substances. Different types of slimming pills are popular among women (including hormone preparations), but possibly even more interesting are the new female fitness and appearance ideals that are connected to muscles and strength. The body has become increasingly important for saying something about who we are. The hunt for the perfect appearance creates a situation where denial instead of acceptance of one’s own body influences the individual’s self-image.

A common misconception in today's society is that everything is (or should be) rational and goal-oriented, which we summarized earlier as pragmatic rationalism. We call this pragmatic rationalism a misconception because it misses a historical fact that individuals' actions are and have never been governed entirely by rational motives. Emotional, ethical and existential considerations influence human actions extensively. Solidarity, willingness to share and even self-sacrifice and prioritizing the good of others before one's own are values that have survived many different economic cultures. Even today's extremely individualized society with its focus on reaching success and winning at any price cannot completely suppress these values. There is an inherent contradiction between the crude egoism of modern individualism and its historical development that largely has its origin in the care of humans.

25. What Works? Family Influences on Occupational Aspirations among Descendants of Middle Eastern Immigrants on the Swedish Labour Market

In this article, we examine family influences on occupational aspirations among employed descendants of Middle Eastern immigrants. Using a qualitative approach, we conducted 21 semi-structured interviews with native-born descendants of Middle Eastern immigrants. We present and analyse their interpretations of their parents’ experiences and living conditions before, during and after migration and demonstrate how these interpretations shaped their own occupational aspirations. We discuss parents’ high expectations of their children in relation to ethnic-community valuations of educational and occupational achievements. These high expectations may increase the chances of social mobility but can also become a negative pressure, especially if parents set high standards but cannot help their children to meet those expectations. In these cases, older siblings who possess valuable knowledge of the educational system and labour market can function as important transferrers of resources.

This article explores how descendants of immigrants in Sweden understand labor market conditions, and how such understandings influence their occupational strategies. We interviewed twenty-one Sweden-born individuals with non-Western immigrant parents, and identified three strategies based on our analysis of the data: ‘choosing’ the right job, adapting the habitus, and using cultural capital in flexible ways. The first strategy covers interviewees working in jobs with labor shortages and/or high demand for employees with immigrant background. The second covers interviewees who could learn through failing, with substantial resilience and persistence. The third deals with interviewees who searched for jobs in branches that valued their particular skill set, entailing the importance of being flexible on the labor market.

27. 'Kids' in between? Views on work, gender, and family arrangements among men and women of migrant descent in Sweden

This study used qualitative interviews to explore perceptions of labour market participation in relation to gender norms and parenting ideals among employed Swedish men and women of migrant descent. Using an abductive thematic approach, we demonstrate how the respondents viewed labour market participation from different perspectives. The females saw it as a source of emancipation, whereas the men primarily viewed it as a means of providing for a current/future family. While our respondents depicted themselves as dedicated to social norms of gender equality, they expressed gender-biased views on work and family. The respondents’ immigrant heritage also influenced their views on labour market participation, gender and family. Gender inequalities in the parental generation motivated them to arrange their work and family lives differently, and the Swedish social and political context offered them incentives and opportunities to be more gender-equal than their parents. We view and analyse these findings from a life course-perspective, showing how cultural and contextual influences affect respondents’ perspectives on work and family arrangements.

Although there are a number of studies on policy making concerning doping and anti-doping in elite sports, the athletes’ perspective has largely been neglected. The present study contributes to bridging this gap. Since forming and developing the anti-doping policy utterly depends on how legitimate the practitioners believe this policy to be, the specific aim for this paper is to study how elite athletes at the broad international arena perceive the legitimacy of anti-doping policy and practices. An on-line questionnaire, designed to capture elite athletes’ perceptions, was answered by 261 respondents from 51 different countries and four international sports federations. Respondents were elite athletes belonging to the International Registered Testing Pool of each federation. The respondents were generally supportive towards anti-doping policy. Over 80% agreed that different anti-doping activities, from doping controls and the whereabouts system to storing of test samples and biological passports, are essential parts of the work against doping in sports. Support for anti-doping policy is also shown when 80% of the athletes agreed that anti-doping work should develop in a way that there is the same level of, or more, anti-doping activities compared to the current. The principle of anti-doping is, in this study, shown to be legitimate. However, at the level of practices, four areas were perceived as challenging. Regarding practical procedures, 34% experienced difficulties filing whereabouts information and 73% felt worried that they won’t be available for testing at the right place and right time in correlation to the whereabouts information they had provided. Concerning the athletes’ personal life and privacy, 50% of female athletes and 30% of males stated that they feel somewhat or very uncomfortable regarding their privacy when providing a urine sample. Furthermore, in regard to the whereabouts system, 47% of the respondents stated that they feel monitored. The efficacy and equality of anti-doping work is put under question by 58% who believed that users of forbidden substances/methods escape detection and 44% who did not believe that the whereabouts system is working properly in all countries. 70% of the respondents did not believe that all athletes applying for a therapeutic use exemption are treated in the same way. Regarding the athletes influence and participation in the policy work, 85% believe that athletes should be more involved. These four areas can be seen as unintended consequences of the work and reveal a weak point for the legitimacy of anti-doping when the athletes not fully perceive procedural justice. In conclusion, legitimacy for anti-doping policy in general is strong while a questioning of the legitimacy in the execution of the rules is discerned. If anti-doping authorities wish to maintain and increase the legitimacy of the anti-doping efforts, a thorough understanding for and consideration of the athletes’ perceptions is beneficial.

Anti-doping work is a comprehensive enterprise that entails control and governance of elite athletesâ everyday lives. However, in policy-making regarding doping and anti-doping in elite sports, the athletesâ perspective has not been considered adequately. Focusing on elite athletesâ perceptions of anti-doping as both principle and praxis, the study aimed to analyse how these perceptions can be understood from a legitimacy perspective. A survey study involving 261 elite athletes from 51 different countries and four international sports federations was conducted. The results showed that the athletes did not question the legitimacy of the rules, but had concerns about the legitimacy of the way the rules and principles are enforced in practice, specifically with regard to matters of privacy, lack of efficiency and equal conditions as well as athletesâ involvement in the anti-doping work. The article describes how athletesâ perceptions of the legitimacy of anti-doping work constitute the basis for their willingness to follow regulations as well as a precondition for the workâs functionality and stability. In light of this finding, the article calls for the empowerment of athletes in anti-doping work.

The implementation of global anti-doping regulations was intended to provide a level playing field for all athletes entering sports competitions. However, studies have shown that the worldwide harmonization of rules has not been entirely efficacious. For instance, great variation has been found in how anti-doping organizations implement anti-doping regulations, and it has also been shown that athletes distrust the equivalence of the worldwide rules as regards their effects. The purpose of the present article is to examine how elite athletes from different contexts experience anti-doping procedures and to analyse the legitimacy of anti-doping practice. In order to capture a variety of voices and perspectives, 13 elite athletes from five different continents and three international sports federations were interviewed. The analysis shows that when global anti-doping policy is implemented in different contexts and under different conditions, inequities and structural injustices emerge concerning infrastructure, knowledge and support at the individual athlete level. These consequences may have implications for the legitimacy of anti-doping work, because the existence of procedural justice may be called into question. We therefore suggest that anti-doping policy-making should be based on taking into account these different conditions and being aware of the perspectives that underpin regulations intended to be applied global.

Research in the field of human services has paid limited attention to the consequences of the international development toward organisational specialisation; the consequences for clients have been overlooked in particular. The aim of the article is to describe and analyse the consequences of organizationally specialised personal social services (PSS) in Sweden for clients with complex needs. Findings from a survey and an interview study addressing PSS clients show that clients primarily perceived their encounters with the specialised PSS negatively, and that they experienced several elements of service fragmentation. Implications of the findings are discussed in light of previous research and theory in the area.

Dealing with specialised social service organisations can be a challenge for clients with complex needs. These organisations may appear confusing and hard to navigate, and there is also a risk of service fragmentation, as such clients often participate simultaneously in an array of interventions. An additional complication to be handled is that these parallel interventions can range from voluntary to more or less involuntary. The aim of the present article is to describe and analyse how clients with complex needs account for their handling of service conditions within specialised personal social services (PSS), using data from a qualitative interview study with PSS clients in Sweden. A conceptual model is presented, covering four ideal typical client approaches to these specialised services: consensus, resignation, fight and escape. One key finding is that the clients combined these approaches in a balancing act intended to promote their own best interests in their parallel contacts with different parts of the specialised PSS organisation. The article concludes that future improvements in social services could be made by paying more attention to the structural arrangements that surround encounters between clients and the social services, as well as clients’ valuable first-hand knowledge of social service organisations.

This article highlights organizational structure as a factor influencing conditions for helping relations. It is based on a survey study and an interview study, both directed at parents in families that have parallel contacts in different parts of Swedish personal social services (PSS). The aim is to describe and analyse conditions for helping relations when clients with complex needs encounter specialized PSS.

Low system trust, people processing dimensions of work, and an organizational and a professional emphasis on formal organizational structures and boundaries were found to constitute unfavourable conditions. Conversely, an occurrence of individual trust, people sustaining and people changing dimensions of work, as well as informal organization and individual social workers’ boundary spanning efforts, constituted favourable conditions. The article concludes that greater understanding of how clients are affected by contextual service conditions can give some pointers towards how to generally improve services for vulnerable and disadvantaged populations.

In Europe, equitable access to high-quality healthcare constitutes a key challenge for health systems across the continent. However, the recent economic recession left many outside the labour market, causing many to fall in poverty and social exclusion. Unemployment is probably the main factor leading to social exclusion. Studies which analysed health seeking behaviour among unemployed people have reported a variety of results, from low to high utilization of health services. However, some researchers argue that during stressful economic and social circumstances can cause high utilization of the health care system due to increased psychological disorders masked by physical complaints. This study examined differences in health seeking behaviour in Gävleborg County, which at the pick of the economic recession had high levels of unemployment as compared to the national average.

Methods

The data for the study come from the 2010 Survey of Health in Equal terms carried out in Gävleborg County, Sweden. The sample included 4245 persons aged 16-65 years. Descriptive and binary logistic analysis was used to assess differences in health seeking behavior by employment status.

Results

There was a statistical significant relationship between employment status and health-seeking behavior. Compared to employed persons, people who were out of the labor market had odds ratio of 1.42 (1.12-1.62) for contact with health care services; of 1.30 (1.12-1.50) for contact with a doctor in a health care facility and 1.67 (1.42-1.97) for contact with a doctor in a hospital. Controlling for age, sex, marital status, education, income, smoking habits, physical activity, self-rated health, and long standing illness removed the statistical significance of the observed relationships. Thus, the odds for contact with health care services went from.

Conclusions

At the pic of the recent economic recession, people who were outside the labor market had more contact with health care services, with doctor in hospitals as well as primary health care services as compared to employed counterparts. The differences in health seeking behavior were explained by demographic, socioeconomic and health variables.

Background: In the past decade, temporary employment arrangements, including fixed-term and sub-contracted jobs, as well as project work, on-call work and work via temporary-help agencies have increased in developed countries, including Sweden. The objective of this study was to explore precariously employed individuals’ experiences and perceptions of employment strain and its effect on their psychological well-being in Gävleborg County, Sweden. Methods: Semi-structured interviews were conducted with 16 respondents residing in Gävleborg County about their experiences of precarious employment and their perceptions of the relationship between their precarious employment and psychological well-being. Thematic analysis was conducted to relate the results to the employment strain framework. Results: The main theme to emerge in the data was managing stress. Respondent’s perceived significant stress related to keeping employment as well as having future work. In addition, they had difficulties in coping with everyday life because of economic strain, lack of work opportunities and isolation. Conclusions: The results of this study highlight how precariously employed individuals are unable to cope with the stress related to uncertainty in maintaining their current work or having control of their working hours. In addition, the results indicate that precariously employed workers experience economic strain related to income uncertainty, which affects their ability to cope with daily life.

Introduction: The most recent economic recession left many people outside the labour market world-wide, causing widespread poverty and social exclusion. Gävleborg County in East Central Sweden experienced massive layoffs caused by closure of various industries. Objective: The objective of this study was to investigate differences in health-care use according to employment status at the pick of the recent economic recession. Methods: The study used data from a cross-sectional survey “Health in Equal Terms” carried out in Gävleborg County in 2010. The sample included 4245 persons aged 16-65 years. Descriptive and logistic regression analyses were used to assess differences in health-care seeking behaviour by employment status. Results: Employment status was statistically significantly associated with health-care use in Gävleborg County. In the bivariate analysis people who were not employed had odds ratio of 1.62 (CI 1.18-1.72) for health care use as compared to their employed counterparts. Controlling for other variables in Model II to IV removed the statistical significance and reduced the odds to 0.44(CI 0.20-1.00). Conclusions: This study found that at the pick of the most recent economic recession, people who were out of work used more often health services as compared with their employed counterparts. The observed differences in health-care use were explained by demographic, socio-economic and health-related variables. Further studies are needed to analyze trends of healthcare utilization according to employment nationally, particularly at the county level.

This paper aims to provide a description of the new bachelor programme “Health Promotion through Sustainable Development”, which started in autumn 2016 at the University of Gävle, Faculty of Health and Working Life. The programme was built integrating public health and biology through a thread of health promotion and sustainable development across the three years of study. In the era of sustainable development and more complex health threats, future public health professionals need to be equipped with the right knowledge and skills that will enable them to promote a sustainable population health.

Objective: Suicidal ideation have been found to be a strong predictor of suicide attempt as well as completed suicide. Currently, there is an on-going debate on the impact of the recent economic recession on mental health outcomes, including suicide behaviours. Northern Sweden continues to bear the consequences of the recent recession which started in 2008.Thus, this study investigates differentials in twelve months suicidal ideation by socio-economic position (SEP) among economically active persons residing in Västernorland County. In addition, the study discusses the importance of employment status as a fourth measure of socio-economic position in the context of economic hardship.

Method:The study uses cross-sectional data from the 2010 Västernorrland in 2010 “Health on Equal Terms Survey”, which consisted of 5,050 in economically active persons aged 16-65 years. Descriptive and weighted regression analyses were performed and results are presented as OR´s (with 95% confidence intervals).

Results:Suicidal ideation was statistically significantly associated with SEP as measured by education, occupation, income and employment status. Respondents who had primary education, were manual workers, or had lower income and were out of work had odds ratios of 2.19 (CI 1.51-3.16); 2.95 (CI 2.04-4.27); 3.40 (CI 2.41-4.79) and 3.24 (CI 2.84-4.21), respectively. Controlling for demographic, socio-economic and health-related variables only eliminated the statistical significance for education and income.

Conclusion:SEP as measured by education, occupation, income and employment was associated with suicide ideation in Västernorrland County. Also, employment status was found to be an important measure of SEP within the context of economic recession. There is a need for social protective policies for the less privileged in the population at all times, but especially during times of economic crises.

41. Fear of crime and its relationships to self-reported health and stress among men

Background: Fear of crime is a growing social and public health problem globally, including in developed countries such as Sweden. This study investigated the impact of fear of crime on self-reported health and stress among men living in Gävleborg County.Design and Methods: The study used data collected from 2993 men through a cross sectional survey in the 2014 Health in Equal Terms survey. Descriptive and logistic regression analyses were carried out to study the relationship between fear of crime and self-reported health and stress. Results: There was a statistically significant association between fear of crime and self-reported poor health and stress among men residing in Gävleborg County. In the bivariate analysis, men who reported fear of crime had odds of 1.98 (CI 1.47- 2.66) and 2.23 (CI 1.45-3.41) respectively. Adjusting for demographic, social and economic variables in the multivariate analysis only reduced the odds ratio for self-reported poor health to 1.52 (CI 1.05-2.21) but not for self-reported stress with odds of 2.22 (1.27-3.86). Conclusions: Fear of crime among men was statistically significantly associated with self-reported poor health and stress in Gävleborg County. However, the statistically significant relationship remained even after accounting for demographic, social and economic factors, which warrants further research to better understand the role played by other variables.

The main purpose of this article is to examine how elite athletes perceive their own responsibilities and possibilities to be compliant with the anti-doping regulations, and to draw conclusions about what these perceptions mean in relation to the legitimacy of the anti-doping system. A qualitative research design, with interviews conducted with athletes globally, was employed to capture elite sportspersons’ views on anti-doping policy and procedures. The analysis was based on a theoretical framework on legitimacy. The findings show that athletes’ situation is characterized by limited information and a lack of leeway. At the same time, athletes find themselves obliged to be dutiful. We discuss the complex situation of simultaneously facing perceived limitations and duties, and consider the limits that athletes experience in relation to compliance, which may place the legitimacy of the anti-doping system at risk.

The global anti-doping effort in sport is based upon perceptions of the system as desirable, proper and appropriate and thus considered legitimate. The legitimacy of the anti-doping system has earlier been studied bottom-up, based on the views of athletes. In order to gain greater understanding of legitimation processes, it is also important to study legitimation strategies top-down, used by decision-making and governing bodies. The aim of this study was to use Fairclough's critical discourse analytical approach to analyse the social construction of legitimacy in the World Anti-Doping Agency's three editions of a guide to anti-doping rules aimed at athletes. The analysis was performed based on van Leeuwen's four specific legitimation strategies: authorization, rationalization, moral evaluation and mythopoesis. Our analysis shows that the legitimation of the anti-doping discourse as constructed in the athlete guides that has accompanied anti-doping regulations for more than a decade is characterized by continuity as regards an authoritarian attitude, but also by change towards a more rational and athlete-centred stance. A shift can be seen in the construction of legitimacy in the anti-doping discourse from “fighting the bad” to “protecting the good”. We discuss the moral evaluation strategy as a way to construct legitimacy for anti-doping efforts and sport in general towards a wider public. In the light of the results of this study, we conclude that policymaking in relation to doping issues should take into account the dimension of the discursive top-down legitimation, which could affect how the policy is received at the level of the athletes and provide conditions for a sustainable anti-doping system.